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Giving pertussis vaccine at birth may protect baby if mum did not get vaccine in pregnancy

Using a vaccine not currently licenced in Australia, a report published in the prestigious American journal JAMA Pediatrics, gives results of a National Health and Medical Research Council funded trial led by researchers from NCIRS. This study was a collaboration between NCIRS and the Universities of Sydney, Melbourne, Adelaide, and Western Australia, together with the Murdoch Children’s, Robinson and Telethon Research Institutes. This is the largest ever trial of a pertussis vaccine at birth and included 440 newborns in Sydney, Melbourne, Adelaide and Perth. The trial was designed to show whether also giving pertussis vaccine at birth could protect against life-threatening whooping cough in the first 3 months of life.

The trial used a special pertussis-only vaccine (without diphtheria or tetanus) and randomised infants within 5 days of birth to receive only hepatitis B vaccine (HBV) or HBV and pertussis. Hepatitis B vaccine at birth has been recommended in Australia since 2000. Babies received usual vaccines at 6 weeks, 4 months and 6 months. The study found significantly higher pertussis antibody levels at 6 and 10 weeks of age in babies who had the birth vaccine, levels not achieved until at least 4 months of age currently. Since even one dose of pertussis vaccine provides good protection against death from pertussis, this is a major finding.

Receipt of a birth dose of pertussis vaccine was safe and well-tolerated, with no increase in side effects compared with HBV only. Since the trial started, data from a country-wide emergency programme in England have shown giving a dose of standard pertussis vaccine (with diphtheria or tetanus) to mothers is effective in preventing severe whooping cough in the first 3 months of life in their infants, and this evidence has resulted in the vaccine being provided for all pregnant women through the Australian National Immunisation Program from July 2018. However, infants whose mothers are not vaccinated or are born prematurely are not protected. The pertussis-only vaccine is an attractive option for immunising mothers too. If such a vaccine were licensed and available in Australia, it would provide the full range of options to protect babies younger than 3 months of age from severe pertussis, said Associate Professor Nick Wood, who led this study.

Wood N, Nolan T, Marshall H, et al. Immunogenicity and Safety of Monovalent Acellular Pertussis Vaccine at BirthA Randomized Clinical Trial. JAMA Pediatr. Published online September 10, 2018. doi:10.1001/jamapediatrics.2018.2349